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Cerebral palsy is a spectrum of developmental disorders that result from a non-progressive insult to the developing brain in utero or early life. Characteristically, muscle tone and movement are affected but there is wide variation in the degree to which each individual is affected 1.
The incidence of cerebral palsy is approximately 2 per 1000 live births 2.
Risk factors include:
prematurity (particularly earlier than 32 weeks gestation)
low birthweight (particularly <1500 g)
infection during pregnancy
neonatal meningitis or head injury
The diagnosis is usually not made at birth but becomes apparent in early childhood due to delay in reaching developmental or motor milestones, such as difficulty walking or sitting.
Classification is usually based on the characteristics of the symptoms:
spastic: most common (80%), characterized by increased tone, and often qualified by the parts of the body affected
diplegic: affecting the lower limbs predominantly
hemiplegic: affecting the leg and arm on one side of the body, with the arm often less affected
quadriplegic: all four limbs affected, the most severe form, usually associated with developmental delay, seizures and other neurological sequelae
ataxic: due to cerebellar involvement, characterized by difficulties with balance and coordination
dyskinetic: characterized by random movements
However, such a classification system is a blunt tool and does not adequately capture the range of disability that might be experienced by each individual within each category. For this reason, functional classification systems such as the Gross Motor Function Classification System (GMFCS) are used to more usefully classify the functional ability of each individual 3.
There is no single pathological manifestation of cerebral palsy, as many different insults to the developing brain can cause it. The insult to the brain is static but the manifestation of symptoms can change over time due to growth and development.
Since there is no single pathological manifestation of cerebral palsy, the imaging appearances of the causative condition can be widely variable.
Conditions that may manifest as causing cerebral palsy include:
Treatment and prognosis
This depends significantly on the severity of the condition, but since the insult to the brain is static, treatment is focused on managing the symptoms and multidisciplinary support for development.
History and etymology
Cerebral palsy was first studied by English physician William John Little (1810-1894), but the term was coined by Canadian physician Sir William Osler (1849-1919) in 1888 4.
- 1. Lissauer T, Carroll W. The Science of Paediatrics. (2016) ISBN: 9780702063138
- 2. Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. (2013) Developmental medicine and child neurology. 55 (6): 509-19. doi:10.1111/dmcn.12080 - Pubmed
- 3. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. (1997) Developmental medicine and child neurology. 39 (4): 214-23. doi:10.1111/j.1469-8749.1997.tb07414.x - Pubmed
- 4. Pietrzak K, Grzybowski A, Kaczmarczyk J. William John Little (1810-1894). J Neurol. 2016;263(5):1047-9. doi:10.1007/s00415-015-7890-5 - Pubmed